Mulligan SNAG Versus Active Release Technique in Cervicogenic Headache

Overview

This study is designed to compare two different manual therapy approaches for individuals with cervicogenic headaches, a type of headache that originates from the neck. Participants will be randomly assigned to one of two groups. The first group will receive Mulligan mobilization using sustained natural apophyseal glides (SNAG) along with a home program of Mobilization self-SNAG exercises. The second group will receive the Active Release Technique (ART) combined with a home program of stretching and strengthening exercises for the neck and shoulder muscles. Each participant will attend treatment sessions three times per week for four weeks. Pain levels, headache impact, and neck function will be evaluated at the start, after four weeks of treatment, and again at eight weeks to determine which method provides better outcomes.

Cervicogenic headache is a form of secondary headache caused by dysfunction in the cervical spine. It is often associated with neck pain, restricted mobility, and limitations in daily activities. Manual therapy, combined with targeted exercises, is frequently used in rehabilitation to reduce pain and improve neck function. This randomized controlled trial aims to compare the effectiveness of Mulligan mobilization with sustained natural apophyseal glides (SNAG) versus the Active Release Technique (ART) in the treatment of cervicogenic headache. Group A - Mulligan Mobilization SNAG and Home Exercise: Participants in this group will receive the Headache SNAG technique, which involves a gentle, sustained postero-anterior glide of the second cervical vertebra for 10 to 30 seconds to help reduce headache intensity. If relief is noted, up to six repetitions may be performed. In addition, each participant will be prescribed a home program consisting of C1-C2 self-SNAG rotation using a towel to apply pressure on the posterior arch of C1 during active cervical rotation. The exercise will be completed twice daily, with 10 repetitions per session. Written instructions will be given to ensure correct performance and better compliance. Group B - Active Release Technique and Home Exercise Program: Participants allocated to this group will receive the Active Release Technique (ART), a hands-on treatment aimed at releasing tight muscles and improving soft tissue mobility. During ART, controlled pressure is applied to specific muscles while the neck is moved to restore normal function and reduce discomfort. Target muscles include the pectoralis major, upper trapezius, levator scapulae, rhomboids, deep neck flexors, and serratus anterior. The intervention will also include a structured exercise program designed to stretch and strengthen the neck and shoulder muscles, reduce tension, and enhance posture. Stretches will consist of sitting chair stretch, Brugger's stretch, wall angles, and doorway stretches. Strengthening activities such as the Kibler squeeze and head/neck retractions will also be incorporated. The home program will begin with gentle neck stretches, such as tilting the head toward one shoulder and holding the position for 20-30 seconds, repeating three times on each side. Chin tucks will be performed by gently retracting the chin without tilting the head, holding for 5 seconds, and repeating 10 times for 2-3 sets. These exercises aim to relieve muscle tightness, improve alignment, and help alleviate headache symptoms.